Vertebral implants and attachment assemblies

ABSTRACT

A prosthetic implant for engagement between first and second vertebrae. The implant includes a first plate configured for attachment to the first vertebrae and defining a first interbody connection member and a second plate configured for attachment to the second vertebrae and defining a second interbody connection member. An interbody component includes a body with a first end defining a first plate connection member configured for connection to the first interbody connection member and a second end defining a second plate connection member configured for connection to the second interbody connection member. A method of inserting the implant is also provided.

FIELD OF THE INVENTION

The present disclosure relates to systems and devices for interbodyfusion and/or supporting the spine after removal of at least a part of avertebra. More particularly, the disclosure relates to interbodyimplants and vertebral body replacement implant assemblies andattachment assemblies.

BACKGROUND OF THE INVENTION

When a vertebra is damaged or diseased, surgery may be used to replacethe vertebra or a portion thereof with a prosthetic device to restorespinal column support. For example, vertebral body replacement iscommonly required in the treatment of vertebral fracture, tumor, orinfection.

Corpectomy surgeries are typically comprised of two parts. The firstpart includes resection of a portion or all of a one or more vertebralbodies and replacement of resected bone with a VBR (vertebral bodyreplacement) graft. The second part includes stabilizing of the VBRgraft using plating on the anterior aspects of the vertebral bodies or,more commonly; posterior screws with rods. The VBR graft may be attachedto the posterior rods and/or screws used for stabilization. There arethree aspects to achieving this: 1) attaching the stabilizer to the VBR,2) attaching the stabilizer to the posterior rod, and 3) controlling thelength of the stabilizer between the VBR and the posterior rod.

Another solution is to insert an implant or spacer in place of the discto restore the height and to promote fusion between adjacent vertebralbodies. In some embodiments, additional fixation, in the form of platesor rods, may also be needed to stabilize the spinal segment. Theinterbody fusion devices may be used following a discectomy procedure topromote fusion between the vertebrae.

In recent years, several artificial materials and implants have beendeveloped, such as, for example, titanium cages, ceramic, ceramic/glass,plastic or PEEK, and carbon fiber spacers. Recently, various expandableprosthetics or expandable cages have been developed and used forvertebral body replacement and/or interbody fusion. The expandableprosthetic devices are generally adjustable to the size of the cavitycreated by a corpectomy procedure or the disc space and typically are atleast partially hollow to accommodate bone cement or bone fragments tofacilitate fusion in vivo. Some expandable implants may be adjustedprior to insertion, while others may be adjusted in situ.

Many expandable implant systems are reliant on distraction of theinterbody component, however, such a procedure can be complicated andlimit the size of the interbody as the distraction instrument interfereswith the insertion of the interbody component.

Another disadvantage with many traditional expandable VBR cages andinterbody implants is that they have limited internal space for packingbone graft materials which may inhibit their ability to aid fusion.Additionally, traditional mesh VBR cages cannot be expanded and so aredifficult to insert from many surgical approaches.

SUMMARY OF THE INVENTION

To meet these and other needs, devices, systems, and methods forproviding vertebral body replacement and/or interbody implants areprovided. In particular, implant systems and attachment assemblies areprovided. Fixing individual plates directly to the vertebral bodiesallows for a customized fit to varying vertebral body morphology.Features on the plates that allow distraction or compression allow forthe interbody component to be placed into a small/tight space moreeasily than any system reliant on interbody distraction as theinstrument does not interfere with the insertion of the interbodycomponent. If the interbody component can be custom fitted/cut to theexact space between the plates, a custom ‘best’ fit can be obtained withminimized stress concentrations placed on the vertebral bodies.

Fixing the VBR graft to the posterior rod(s) improves constructstiffness and reduces migration of the VBR. The attachment assembliesdescribed herein provide ease of use, precise control of distancebetween the VBR graft and posterior rods, attach to differing geometriesand posterior rod attachment mechanisms that attach from multipleangles.

In at least one embodiment, a prosthetic implant for engagement betweenfirst and second vertebrae is provided. The implant includes a firstplate configured for attachment to the first vertebrae and defining afirst interbody connection member and a second plate configured forattachment to the second vertebrae and defining a second interbodyconnection member. An interbody component includes a body with a firstend defining a first plate connection member configured for connectionto the first interbody connection member and a second end defining asecond plate connection member configured for connection to the secondinterbody connection member. A method of inserting the implant is alsoprovided.

In at least one embodiment, a prosthetic implant for engagement betweenfirst and second vertebrae and including first and secondinterdigitating bodies is provided. The first body includes a firstplate with a plurality of spaced apart first legs extending from thefirst plate. At least two of the first legs define inwardly extendingfirst projections. The second body includes a second plate with aplurality of spaced apart second legs extending from the second plate.At least one of the second legs is an expandable leg and defines secondprojections along its outward edges. The first and second bodies areinterdigitated such that the first legs extend into the spaces definedbetween the second legs and the second legs extend into the spacesdefined between the first legs in an orientation wherein the secondprojections are aligned with the first projections. A locking mechanismis configured to engage the expandable leg and splay the outward edgesoutward such that the second projections engage and lock with the firstprojections.

In at least one embodiment, a prosthetic implant assembly including avertebral body replacement graft, a posterior rod spaced a distance fromthe vertebral body replacement graft and an adjustable stabilizer isprovided. The adjustable stabilizer is configured such that adjustmentof the adjustable stabilizer adjusts the distance between the vertebralbody replacement graft and the posterior rod.

Although generally described herein with reference to VBR where acorpectomy has taken place, it will be appreciated that likewise theembodiments may apply equally to an interbody fusion where only adiscectomy has occurred and the vertebra or vertebrae remain in place.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated herein and constitutepart of this specification, illustrate the presently preferredembodiments of the invention, and, together with the general descriptiongiven above and the detailed description given below, serve to explainthe features of the invention. In the drawings:

FIG. 1 is a side elevation view of an implant assembly according to anexemplary embodiment attached between vertebrae.

FIG. 2 is a side elevation view of an alternative plate of the implantassembly attached to a vertebra.

FIG. 3 is a side elevation view illustrating an exemplary implantationof the implant assembly of FIG. 1 utilizing a distraction/compressioninstrument.

FIG. 4 is an exploded rear elevation view of an exemplary interbodycomponent and plate of the implant assembly of FIG. 1.

FIG. 5 is a side elevation view illustrating the interbody component andplate of FIG. 4 in an assembled condition.

FIG. 6 is an exploded isometric view of an implant assembly inaccordance with another embodiment.

FIG. 7 is an exploded rear elevation view of an interbody component, anexpansion component and plate of an implant assembly in accordance withanother embodiment.

FIG. 8 is a rear elevation view of an interbody component and plate ofan implant assembly in accordance with another embodiment.

FIG. 9 is an exploded rear elevation view of an interbody component andplate of an implant assembly in accordance with another embodiment.

FIG. 10 is a cross-sectional view of an interbody component and plate ofan implant assembly in accordance with another embodiment.

FIG. 11 is a top plan view of an interbody component and plate of animplant assembly in accordance with another embodiment.

FIG. 12 is a cross-sectional view along the line 12-12 of FIG. 11.

FIG. 13 is an exploded isometric view of an interbody component andplate of an implant assembly in accordance with another embodiment.

FIG. 14 is an exploded isometric view of an interbody component andplate of an implant assembly in accordance with another embodiment.

FIG. 15 is an exploded isometric view of an interbody component andplate of an implant assembly in accordance with another embodiment.

FIG. 16 is an exploded isometric view of an implant assembly inaccordance with another embodiment.

FIG. 17 is an assembled isometric view of the implant assembly of FIG.16.

FIG. 18 is an isometric view of an implant assembly in accordance withanother embodiment.

FIG. 19 is an isometric view of an implant assembly in accordance withanother embodiment.

FIG. 20 is a cross-sectional view along the line 20-20 in FIG. 19.

FIG. 21 is a schematic plan view of a vertebral body replacement (VBR)graft, stabilizer and posterior rods positioned relative to a vertebra.

FIG. 22 is an isometric view of an exemplary embodiment of a VBR graftattachment assembly.

FIG. 23 is an isometric view of another exemplary embodiment of a VBRgraft attachment assembly.

FIG. 24 is a top plan view of an exemplary embodiment of a VBR graftattachment assembly.

FIG. 25 is an isometric view of another exemplary embodiment of a VBRgraft attachment assembly.

FIG. 26 is an isometric view of another exemplary embodiment of a VBRgraft attachment assembly.

FIG. 27 is an exploded isometric view of another exemplary embodiment ofa VBR graft attachment assembly.

FIG. 28 is an exploded isometric view of another exemplary embodiment ofa VBR graft attachment assembly.

FIG. 29 is an isometric view of another exemplary embodiment of a VBRgraft attachment assembly.

FIG. 30 is an isometric view of another exemplary embodiment of a VBRgraft attachment assembly.

FIG. 31 is a cross-sectional view along the line 31-31 in FIG. 30.

FIG. 32 is an isometric view of another exemplary embodiment of a VBRgraft attachment assembly.

FIG. 33 is an isometric view of another exemplary embodiment of a VBRgraft attachment assembly.

FIG. 34 is a top plan view of another exemplary embodiment of a VBRgraft attachment assembly compressed using a distraction/compressioninstrument.

FIG. 35 is a top plan view of another exemplary embodiment of a VBRgraft attachment assembly.

FIG. 36 is a top plan view of another exemplary embodiment of a VBRgraft attachment assembly.

FIG. 37 is a top plan view of another exemplary embodiment of a VBRgraft attachment assembly.

FIG. 38 is a top plan view of another exemplary embodiment of a VBRgraft attachment assembly.

FIG. 39 is a top plan view of another exemplary embodiment of a VBRgraft attachment assembly.

FIG. 40 is a top plan view of another exemplary embodiment of a VBRgraft attachment assembly.

FIG. 41 is a top plan view of another exemplary embodiment of a VBRgraft attachment assembly.

FIG. 42 is a top plan view of another exemplary embodiment of a VBRgraft attachment assembly.

FIG. 43 is a top plan view of another exemplary embodiment of a VBRgraft attachment assembly.

FIG. 44 is a top plan view of another exemplary embodiment of a VBRgraft attachment assembly.

FIG. 45 is a top plan view of another exemplary embodiment of a VBRgraft attachment assembly.

FIG. 46 is a top plan view of another exemplary embodiment of a VBRgraft attachment assembly.

FIG. 47 is an exploded top plan view of another exemplary embodiment ofa VBR graft attachment assembly.

FIG. 48 is an exploded top plan view of another exemplary embodiment ofa VBR graft attachment assembly.

FIG. 49 is an exploded top plan view of another exemplary embodiment ofa VBR graft attachment assembly.

FIG. 50 is a top plan view of another exemplary embodiment of a VBRgraft attachment assembly.

FIG. 51 is an isometric view of an exemplary embodiment of a posteriorrod attachment assembly.

FIG. 52 is an isometric view of another exemplary embodiment of aposterior rod attachment assembly.

FIG. 53 is an isometric view of another exemplary embodiment of aposterior rod attachment assembly.

FIG. 54 is a top plan view of another exemplary embodiment of aposterior rod attachment assembly.

FIG. 55 is an exploded isometric view of another exemplary embodiment ofa posterior rod attachment assembly.

FIG. 56 is an exploded isometric view of another exemplary embodiment ofa posterior rod attachment assembly.

FIG. 57 is an exploded isometric view of another exemplary embodiment ofa posterior rod attachment assembly.

FIG. 58 is an exploded isometric view of another exemplary embodiment ofa posterior rod attachment assembly.

FIG. 59 is a top plan view of another exemplary embodiment of aposterior rod attachment assembly.

FIG. 60 is a top plan view of another exemplary embodiment of aposterior rod attachment assembly.

FIG. 61 is a side elevation view of another exemplary embodiment of aposterior rod attachment assembly.

FIG. 62 is a top plan view of another exemplary embodiment of aposterior rod attachment assembly.

FIG. 63 is a top plan view of another exemplary embodiment of aposterior rod attachment assembly.

FIG. 64 is an isometric view of an exemplary embodiment of an adjustablestabilizer.

FIG. 65 is an isometric view illustrating adjustment of the length ofthe adjustable stabilizer of FIG. 64 using a distraction/compressioninstrument.

FIG. 66 is an isometric view of another exemplary embodiment of anadjustable stabilizer.

FIG. 67 is a top plan view of another exemplary embodiment of anadjustable stabilizer.

FIG. 68 is a side elevation view of another exemplary embodiment of anadjustable stabilizer.

FIG. 69 is a side elevation view of another exemplary embodiment of anadjustable stabilizer.

FIG. 70 is a top plan view of another exemplary embodiment of anadjustable stabilizer.

FIG. 71 is a top plan view of another exemplary embodiment of anadjustable stabilizer in a first condition.

FIG. 72 is a top plan view of the adjustable stabilizer of FIG. 71 in astretched condition.

DETAILED DESCRIPTION OF THE INVENTION

In the drawings, like numerals indicate like elements throughout.Certain terminology is used herein for convenience only and is not to betaken as a limitation on the present invention. The following describespreferred embodiments of the present invention. However, it should beunderstood, based on this disclosure, that the invention is not limitedby the preferred embodiments described herein.

Referring to FIGS. 1 and 3-5, an exemplary embodiment of an implantassembly 100 will be described. The implant assembly 100 is illustratedpositioned between a pair of vertebrae 10. The implant assembly 100generally includes a pair of plates 110 with an interbody component 200secured between the plates 110. In the present embodiment, each plate110 has a generally L-shaped configuration with a lateral portion 112connected to a vertical portion 114 via a bend portion 113. Asillustrated in FIG. 1, the bend portion 113 and the lateral and verticalportions 112, 114 may have a configuration which complements theconfiguration of the vertebrae 10 or other structure to which the plate110 is connected. The plates 110 are not limited to such and may haveother configurations, for example, a right angle between the lateralportion 112 and vertical portion 114 such that the plate 110 may havemore universal use. As another alternative, one or both of the plates110′ may include only the lateral portion 112 ^(iv) such that the plate110′ only extends along the facing surface of the vertebrae, asillustrated in FIG. 2.

With reference to FIGS. 1, 2 and 4, in the illustrated embodiments, eachof the plates 110, 110′ includes one or more screw holes 117 whichfacilitate connection of the plate 110 to a respective vertebra viascrews 130. While screws are illustrated, other fasteners mayalternatively or additionally be utilized to connect the plates 110,110′ to the vertebrae, for example, pins, staples or spikelocking/blocking mechanisms. The plates 110, 110′ are secured to thevertebral body 10 at the level(s) above and/or below the operativelevel(s).

Each of the plates 110, 110′ also preferably includes an instrumentreceiving opening 115. With reference to FIG. 3, an exemplary implantinstrument 20 includes a pair of crossing branches 22, 24, with eachbranch 22, 24 including a respective tip 23, 25 configured to bereceived in an instrument receiving opening 115. With the plates 110secured to the vertebrae 10 and the tips 23, 25 received in therespective instrument receiving openings 115, the instrument 20 caneasily facilitate distraction or compression of the vertebrae 10. Whileinstrument receiving openings are illustrated, the plates 110, 110′ maybe provided with other features which facilitate engagement by theimplant instrument 20.

Fixing the individual plates 110 directly to the vertebral bodies allowsfor a customized fit to varying vertebral body morphology. Distractionor compression via the plates 110, 110′ allows for the interbodycomponent 200 to be placed into a small/tight space more easily thansystems which are reliant on interbody distraction as the instrumentdoes not interfere with the insertion of the interbody component.Positioning a custom fit/cut interbody component 200 into the exactspace between the distracted/compressed plates, a custom ‘best’ fit canbe obtained with minimized stress concentrations placed on the vertebralbodies.

While the interbody component 200 is illustrated as a solid tubularmember, it is understood that the interbody component 200 is not limitedto such. The interbody component 200 can have central hole(s) to allowbone graft materials be placed. It can also have hole(s) through itsexternal walls that allow placement of grafting material. The interbodycomponent 200 can be fixed in height or can be an expanding body, forexample, as described in U.S. Pat. No. 8,591,585.

Referring to FIGS. 4 and 5, to facilitate connection of the interbodycomponent 200 to the plates 110, the interbody component 200 includesconnection members at each end 201, 203 thereof which complementconnection members of the plates 110. In the illustrated embodiment,each end 201, 203 of the interbody component 200 includes a dovetailshaped projection 204, 206 which slidingly engages a correspondingdovetail shaped slot 116 in the plate 110.

Referring to FIG. 6, the plates 110, 110″ within the implant assembly100′ may have different configurations, with the interbody member 200′having different end configurations to mate with the different plateconfigurations. In the illustrated embodiment, the plate 110 is asdescribed above with a dovetail shaped recess 116 configured to receivethe dovetail shaped projection 204 on the interbody component 200′. Theother plate 110″ includes a dovetail shaped projection 118 instead of aslot. The dovetail shaped projection 118 is configured to be received ina dovetail shaped slot 208 on the end 203′ of the interbody component200′. The dovetail shaped projection 118 is also preferably configuredto be received into the dovetail shaped slot 116 on the opposite plate110 such that the plates 110, 110″ may be directly connected, omittingthe interbody component.

It is further understood that the complimentary connecting elements donot have to have a dovetail shape. For example, the embodimentillustrated in FIG. 7 shows the plate 110′″ having a pair of T-shapedslots 119 and the interbody component 200″ having complementary T-shapedprojections 210 at the end 201′. Additionally, an extension component220 is configured to be positioned between the interbody component 200″and the plate 110′″ to customize the length of the interbody componentbetween the plates. The extension component 220 has complementaryconnecting elements, namely, T-shaped slots 224 and T-shaped projections226.

As another exemplary alternative, FIG. 8 illustrates an embodimentwherein the plate 110 ^(vii) includes an extension 121 with a sphericalhead 120. The spherical head 120 is configured to be received in a slot212 having a circular cross-section in the end 201′″ of the interbodycomponent 200′″. Engagement of the spherical head 120 in the circularslot 212 allows omnidirectional adjustment between the plate 110 ^(vii)and the interbody component 200′″.

With reference to FIGS. 9-15, exemplary connecting configurations withadditional locking mechanisms will be described. In the embodimentillustrated in FIG. 9, the plate 110 has a dovetail slot 110 while theend 201′″ has dovetail shaped projection 204′ which is expandable afterit is positioned within the slot 110. To facilitate expansion, a notch214 extends through the interbody component 200 ^(iv). To lock theinterbody component 200 ^(iv) relative to the plate 110, a tapered screw215 is threaded into the notch 214 such that the dovetail shapedprojection 204′ expands as the screw 215 is advanced.

In the embodiment illustrated in FIG. 10, the interbody component 200^(v) includes an annular groove 216 in the end 201 ^(iv). A locking pin123 is positioned within a chamber 122 in the lateral portion 112″ ofthe plate 110 ^(v). A spring 124 biases the pin 123 into engagement withthe annular groove 216 to lock the interbody component 200 ^(v) relativeto the plate 110 ^(v).

In the embodiment illustrated in FIGS. 11 and 12, the interbodycomponent 200 ^(v) again includes an annular groove 216 in the end 201^(iv). A slot 125 in the lateral portion 112′″ of the plate 110 ^(vi) isconfigured to receive opposed leaf springs 126 which extend into theannular groove 216 to lock the interbody component 200 ^(v) relative tothe plate 110 ^(iv).

In the embodiment illustrated in FIG. 13, the lateral portion 112 ^(iv)of the plate 110 ^(vii) includes a bore 127 in the lower surfacethereof. The interbody component 200 ^(vi) has a complementary shape tothe bore 127 and includes a screw receiving hole 218 in the end 201^(v). A screw 129 extends through a hole 128 in the lateral portion 112^(iv) of the plate 110 ^(vii) and into the screw receiving hole 218 tolock the interbody component 200 ^(vi) relative to the plate 110 ^(vii).

In the embodiment illustrated in FIG. 14, the lateral portion 112 ^(v)of the plate 110 ^(viii) includes a threaded bore 130 in the lowersurface thereof. The interbody component 200 ^(vii) has a complementaryshape to the bore 127 and includes threads 220 at the end 201 ^(vi). Thethreads 220 are threadably secured into the threaded bore 130 to lockthe interbody component 200 ^(vii) relative to the plate 110 ^(viii).

In the embodiment illustrated in FIG. 15, the lateral portion 112 ^(vi)of the plate 110 ^(ix) includes a slot 132 configured to receive the end201 ^(vii) of the interbody component 200 ^(viii). A screw 129 extendsthrough a hole 128 in the lateral portion 112 ^(vi) of the plate 110^(ix) and into engagement with the interbody component 200 ^(viii) tolock the interbody component 200 ^(viii) relative to the plate 110^(ix).

Fixing of the plate to the interbody component is not limited to thedescribed embodiments. Other methods of connection may also be utilized,for example, setscrews, pins, staples, rivets, adhesives, and otherspring connections.

Referring to FIGS. 16 and 17, an implant assembly 300 in accordance withanother embodiment will be described. The implant assembly 300 includesa pair of cage bodies 310 and 320 which interdigitate and can beseparated and locked in position relative to one another. The first cagebody 310 includes a plate 312 with a plurality of legs 314, 316 and 318extending therefrom. The legs 314, 316, 318 are radially spaced from oneanother to define respective spaces 311, 313, 315. At least two of thelegs 316, 318 define a series of inwardly extending projections 319.

The second cage body 320 includes a plate 322 with a plurality of legs324, 326 and 328 depending therefrom. The legs 324, 326, 328 areradially spaced from one another to define respective spaces 321, 323,325. The leg 328 has projections 329 extending along each edge. A slot331 extends into the leg 328 between the projections 329 with a screwreceiving opening 332 along the slot 331.

The interdigitating bodies 310 and 320 slide together with the legs 314,316, 318 received in the spaces 321, 323, 325 of the body 320 and thelegs 324, 326, 328 received in the spaces 311, 313, 315. The bodies 310and 320 are oriented relative to one another such that the projections329 are aligned with the projections 319. The bodies 310 and 320 can beseparated from one another by a distractor-type instrument, for example,the instrument 20 illustrated in FIG. 3. Once the bodies 310 and 320have been separated, a tapered screw 330 is advanced into the screwreceiving opening 332 in the leg 328. As the screw 330 is advance, thesides of the leg 328 splay outwardly with the projections 329 engagingthe projections 319. Expansion allows the implant assembly 300 to fitinto a smaller/shorter interbody space and distraction requirements arereduced or eliminated. Additionally, graft packing capacity is maximizedwhen compared to a telescoping expandable design.

FIG. 18 illustrates an alternative embodiment of the implant assembly300′. The implant assembly 300′ is the same as in the previousembodiment except that the screw is replaced by a cam mechanism 340. Thecam mechanism 340 include opposed larger ends 342 and an intermediatecamming portion 344. The camming portion 344 has a double-Dconfiguration such that the camming portion 344 has a height which isgreater than the width. The cam mechanism 340 is positioned in theopening 332 with the ends 342 maintaining the cam mechanism 340 inposition. To lock the bodies 310, 320 relative to one another, the cammechanism 340 is rotated until the height of the camming portion 344extends generally parallel to the plate 322 such that the cammingportion 344 causes the sides of the leg 328 to splay outwardly with theprojections 329 engaging the projections 319.

Referring to FIGS. 19 and 20, an alternative embodiment a body 350 willbe described. The body 350 can be used as one of the interbodycomponents 200 described above, as one of the bodies 310, 320 asdescribed above, or in other interbody structures. The body 350 includesa main body 352 and an adjustable end plate 360 at one or both ends. Theend plate 360 is supported relative to the main body 352 by a pluralityof supports 362, 364 a, 364 b. In the illustrated embodiment, thesupports include a fixed support 362 and a pair of vertically adjustablesupports 364 a and 364 b. The fixed support 362 has a first end 361fixed to the plate 360 and a second end 363 fixed to an end surface 353of the main body 352.

Each of the adjustable supports 364 a, 364 b includes a first end 365fixed to the plate 360 and an adjustment end 367 which extends into aslot 354 in the main body 352. Each adjustment end 367 includes aplurality of grooves 366 configured to engage grooves 372 on a lockingmember 370 within the main body 352. A locking screw 380 extends througha hole 356 in the main body 352 and into a threaded bore 374 in thelocking member 370. Each of the adjustable supports 364 a, 364 b isindependently linearly adjustable to adjust the angle of the plate 360relative to the end surface 353. Once a desired orientation is achieved,the locking screw 380 is advanced such that the grooves 372 of thelocking member 370 are pulled into engagement with the grooves 366 ofthe adjustable supports 364 a, 364 b to lock the adjustable supports 364a, 364 b, and thereby the angle of the plate 360, in position.Adjustability of the plate 360 allows the body 350 to fit with patientanatomy with reduced stress concentrations.

In addition to replacement of resected bone with a VBR (vertebral bodyreplacement) graft, corpectomy surgeries typically also includestabilization using plating on the anterior aspects of the vertebralbodies 10 or, more commonly; posterior screws with rods. Referring toFIGS. 21-72, various components and methods utilized to fix the VBRgraft 400 to the posterior rods 402 via stabilizers 404 will bedescribed. The embodiments illustrated in FIGS. 22-50 illustratecomponents and methods for attaching the stabilizer 404 to the VBR graft400; FIGS. 51-63 illustrate components and methods for attaching thestabilizer 404 to the posterior rod 402; and FIGS. 64-72 illustratecomponents and methods for controlling the length of the stabilizer 404between the VBR graft 400 and the posterior rod 402.

Referring to FIGS. 22-29, the VBR graft 400 includes a collar forattachment of the stabilizer. In each of these embodiments, the collarmay be formed integrally with the VBR or may be manufactured separatelyand connected relative thereto. In the embodiment of FIG. 22, the collar410 is fixedly connected between the ends 401, 403 of the VBR and has adiameter larger than that of the VBR graft 400 such that the collar 410extends radially outwardly therefrom. The stabilizer 404 is configuredto connect to the radially extending collar. Referring to FIG. 23, thefixed collar 410′ is substantially the same as the previous embodimentbut further includes additional fixation for the stabilizer 404, forexample, a bore 412 with an associated screw.

Referring to FIG. 24, the collar 410″ extends partially about the VBRgraft 400. The orientation of the collar 410″ and the stabilizer 404 maybe set and thereafter fixed relative to the VBR graft 400 via a setscrew 416 or the like. Splines 417 or the like may be provided on theinside surface of the collar 410″.

Referring to FIGS. 25-27, the collar is configured to mate with theoutside geometry of the VBR. In the embodiment illustrated in FIG. 25,the VBR graft 400′ is formed with flat sides 405, 407 and the collar410′″ is formed with a complementary configuration. In the embodimentillustrated in FIG. 26, the VBR graft 400″ is formed with an inwardchannel 409 and the collar 410 ^(iv) is formed with a complementaryprojection 418. In the embodiment illustrated in FIG. 27, the VBR graft400″ is formed with outward splines 411 and the collar 410 ^(v) isformed with complementary inward splines 420.

Referring to FIGS. 28-29, the collar is adjustable relative to the VBR.In the embodiment illustrated in FIG. 28, at least a portion of the VBRgraft 400 ^(iv) includes external threads 422 and the collar 410 ^(vi)includes complementary internal threads 424. The collar 410 ^(vi) may bethreadably connected to a desired position along the VBR graft 400^(iv). In the embodiment illustrated in FIG. 29, the collar 410 ^(vii)includes a through hole 425 through which a set screw 426 extends. Oncethe collar 410 ^(vii) is positioned as desired, the set screw 426 isadvanced into position against the VBR graft 400 to lock the position.

Referring to FIGS. 30-31, the VBR graft 400 ^(v) includes an opening 413into an internal chamber 415 in which is positioned an adjustablesupport block 430. The support block 430 includes a split 431 thereinconfigured to receive a locking screw 432. Once the angular orientationof the support block 430 is as desired, the locking screw 432 isadvanced, causing the block 430 to splay into contact with the insidesurface of the chamber 415. Alternatively, a screw may extend throughthe VBR graft 400 ^(v) into engagement with the support block 430 tolock the position of the support block 430.

Referring to FIGS. 32-38, the VBR graft 400 includes a clamp forattachment of the stabilizer. In the embodiment of FIG. 32, the clamp440 includes a collar portion 442 which extends about the VBR graft 400to a pair of opposed legs 441, 443. A screw 444 extends through the legs443, 444. Advancing of the screw 444 brings the legs 441, 443 together,tightening the collar portion 442 about the VBR graft. The stabilizer404 is configured for attachment to the clamp 440. Referring to FIG. 33,the clamp 440′ is substantially the same as the previous embodimentexcept for the collar portion 442′ which includes a plurality of ridges446 or other shapes which complement the stabilizer 404. Referring toFIG. 34, the clamp 440″ is substantially the same as the clamp 440except that in place of a screw, the legs 441, 443 are mechanicallyclamped together using a compression instrument 20.

Referring to FIGS. 35-37, the clamps 440′″, 440 ^(iv), 440 ^(v) eachinclude a first and second collar portions 442 a, 442 b connected to oneanother via a hinge 448. In the embodiment of FIG. 35, each collarportion 442 a, 442 b has a leg 449 extending therefrom and a screw 450is advanced between the legs 449 to splay the legs 449 and thereby bringthe collar portions 442 a, 442 b toward one another. In the embodimentof FIG. 36, the screw 450 extends through one of the legs 449′ intocontact with the other leg 449′. Advancing of the screw 450 causes oneleg 449′ to pivot away from the other leg 449′, thereby bringing thecollar portions 442 a, 442 b toward one another. In the embodiment ofFIG. 37, a closing arm 452 is in contact with one of the collar portions442 b and is engaged by a screw mechanism 454. Rotation of the screwmechanism 454 advances the closing arm 454, thereby bringing the collarportions 442 a, 442 b toward one another.

Referring to FIG. 38, the clamp 440 ^(vi) includes a collar portion 442′with an opening 455 into a central area. The opening 455 has a widthless than the diameter of the VBR graft 400. The collar portion 442′ ismanufactured from an elastomeric material such that the collar portion442′ can deform as it is pressed onto the VBR graft 400 and spring intoa clamped position when fully attached.

Referring to FIGS. 39-40, the VBR graft 400 is secured within a tuliphead 460. In each embodiment, the tulip head 460 includes a bodydefining a U-shaped VBR receiving area 461. A screw 464, cam or the likeis secured in the open end of the body 462, securing the VBR graft 400within the VBR receiving area 461. In the embodiment of FIG. 39, thestabilizer 404 is attached to the body 462 and in the embodiment of FIG.40, the stabilizer 404 is attached to the screw 464.

Referring to FIGS. 41-46, the stabilizer 404 is attached to the VBRgraft 400 via one or more tethers. In the embodiment of FIG. 41, thetether 470 extends about the outside of the VBR graft 400. The ends 471,473 are received and secured in the stabilizer 404. In the embodiment ofFIG. 42, the tether 470 extends through a hole 417 extending through theVBR graft 404 ^(vi) and the ends 471, 473 are received and secured inthe stabilizer 404. In the embodiment illustrated in FIG. 43, the tether470 extends about the VBR graft 400 and the ends 471, 473 are securedwithin a buckle 474 attached to the stabilizer 404. In the embodimentillustrated in FIG. 44, the tether 470 extends about the VBR graft 400and the ends 471, 473 are secured within the stabilizer 404 via a screw476 extending into the stabilizer 404. In the embodiment illustrated inFIG. 45, the tether 470 extends about the VBR graft and each end isattached to a respective rod 402. In the embodiment illustrated in FIG.46, a pair of tethers 470 a, 470 b on opposed sides of the VBR graft400. Each tether 470 a, 470 b has one end attached to a portion 408 ofone stabilizer 404 a and an opposite end attached to a portion 408 ofanother stabilizer 404 b.

In each of the embodiments, the tethers 470 can mate with specificfeatures or no features on the graft and the connection points can befixed or adjustable. Additionally, the tethers 470 can be left loose ortightened locally or remotely.

Referring to FIGS. 47-50, the stabilizer is attached directly to the VBRgraft. In the embodiment illustrated in FIG. 47, the VBR graft 400^(vii) includes a threaded bore 480 defined therein. The stabilizer 404′includes at least a portion of external threads 482 configured tothreadably engage the threaded bore 480. In the embodiment illustratedin FIG. 48, the VBR graft 400 ^(viii) includes a projection withexternal threads 484. The stabilizer 404″ includes a threaded internalbore 485 configured to threadably receive the threaded projection 484.In the embodiment illustrated in FIG. 49, the VBR graft 400 ^(ix)includes a dovetail projection 486. The stabilizer 404′″ includes adovetail slot 487 configured to receive the dovetail projection 486. Inthe embodiment illustrated in FIG. 50, the VBR graft 400 ^(x) includes athrough hole 490 extending therethrough. A bolt 492 extends through thethrough hole 490 and a nut 494 of the stabilizer 404 ^(iv) is tightenedonto the bolt 492.

FIGS. 51-63 illustrate components and methods for attaching thestabilizer 404 to the posterior rod 402. In the embodiment illustratedin FIG. 51, the stabilizer 404 is formed integrally with the rod 402.Similarly, in the embodiment illustrated in FIG. 52, the stabilizer 404is formed integrally with the rod 402′, however, the rod 402′ has areinforced section 500 to distribute loads at the junction.

Referring to FIGS. 53-58, the posterior rod 402 includes a collar forattachment of the stabilizer 404. In each of these embodiments, thecollar may be formed integrally with the stabilizer 404 or may bemanufactured separately and connected relative thereto. In theembodiment of FIG. 53, the collar 502 extends about the rod 402 andincludes a through hole 503 through which a set screw 504 extends. Oncethe collar 502 is positioned as desired, the set screw 504 is advancedinto position against the posterior rod 402 to lock the position.

Referring to FIG. 54, the collar 502′ extends partially about theposterior rod 402. The orientation of the collar 502′ and the stabilizer404 may be set and thereafter fixed relative to the posterior rod 402via the set screw 504. In the embodiment illustrated in FIG. 55, the rod402″ includes a section of exterior splines 505. Splines 506 on theinside surface of the collar 502″ engage the splines 505 to set theorientation of the collar 502″ and stabilizer 404 relative to theposterior rod 402″. The embodiment illustrated in FIG. 56 is similarexcept that the collar 502′″ extends completely around the posterior rod402″. In the embodiment illustrated in FIG. 57, the rod 402′″ includesat least a portion thereof with exterior threads 507. Threads 508 on theinside surface of the collar 502 ^(iv) engage the threads 507 to set thelinear position of the collar 502 ^(iv) and stabilizer 404 relative tothe posterior rod 402′″. The embodiment illustrated in FIG. 58 issimilar except that the collar 502 ^(v) extends completely around theposterior rod 402′″ such that the collar 502 ^(v) may be threaded ontothe rod 402′″.

Referring to FIGS. 59-60, the posterior rod 402 includes a clamp forattachment of the stabilizer 404. In the embodiment of FIG. 59, theclamp 510 includes a collar portion 512 which extends about theposterior rod 402 to a pair of opposed legs 511, 513. A screw 514extends through the legs 513, 514. Advancing of the screw 514 brings thelegs 511, 513 together, tightening the collar portion 512 about theposterior rod 402. The stabilizer 404 is configured for attachment tothe clamp 510. Referring to FIG. 60, the clamp 510′ includes a collarportion 512′ with an opening 515 into a central area. The opening 515has a width less than the diameter of the posterior rod 402. The collarportion 512′ is manufactured from an elastomeric material such that thecollar portion 512′ can deform as it is pressed onto the posterior rod402 and spring into a clamped position when fully attached.

In the embodiment illustrated in FIG. 61, the posterior rod 402 ^(iv)includes a projection 516 with a spherical head 518 and the stabilizer404′ includes a receiving chamber 517 with a complementary sphericalconfiguration. The spherical head 518 is positioned in the receivingchamber 517 and a clamp 519 is affixed about the stabilizer 404′ tomaintain the head 518 within the chamber 517. The spherical head andchamber allow multiaxial fixation between the rod 402 ^(iv) and thestabilizer 404′.

In the embodiment illustrated in FIG. 62, the posterior rod 402 issecured within a tulip head 520. The tulip head 520 includes a body 522defining a U-shaped rod receiving area 521. A screw 524, cam or the likeis secured in the open end of the body 522, securing the posterior rod402 within the rod receiving area 521. In the illustrated embodiment,the stabilizer 404 is attached to the body 522.

Referring to FIG. 63, the stabilizer 404 is attached to the posteriorrod 402 via one or more tethers. In the illustrated embodiment, thetether 530 extends about the outside of the posterior rod 42. The ends531, 533 are received and secured in the stabilizer 404. Tethers may beutilized in other configurations, for example, as illustrated in FIGS.42-44, to connect the stabilizer 404 and posterior rod 402. In each ofthe embodiments, the tethers 530 can mate with specific features or nofeatures on the rod and the connection points can be fixed oradjustable. Additionally, the tethers 530 can be left loose or tightenedlocally or remotely.

FIGS. 64-72 illustrate components and methods for controlling the lengthof the stabilizer 404 between the VBR graft 400 and the posterior rod402. Referring to FIGS. 64-65, the stabilizer 404″ has a telescopingconfiguration. The stabilizer 404″ includes an outer body 540 with areceiving chamber 541 and an inner body 542 configured to be slidablyreceived in the receiving chamber 541. A set screw 544 extends through ahole 543 in the outer body 540 to lock the position of the inner member542 once a desired length between the VBR graft 400 and the posteriorrod 402 is achieved. As illustrated in FIG. 65, a distraction instrument20 or the like may engage the outer and inner bodies 540, 542 to adjustthe length thereof.

The stabilizer 404′″ illustrated in FIG. 66 is similar to that of FIG.64 and includes an outer body 540′ and an inner body 542′. In thepresent embodiment, the receiving chamber 541′ is threaded and the innerbody 542′ has external threads 545 such that the length may bethreadably adjusted.

Referring to FIG. 67, the stabilizer 404 ^(iv) has a hingedconfiguration. A VBR portion 546 is attached to the VBR graft 400 and arod portion 548 is attached to the posterior rod 402. A hinge 547 joinsthe VBR portion 546 and the rod portion 548. The hinge 547 can be lockedor articulated/mechanically driven to push the VBR graft 400 and rod 402apart as well as push them together.

In the embodiment illustrated in FIG. 68, the stabilizer 404 ^(v)provides for multiaxial motion on both ends thereof, however, suchmultiaxial motion may be provided on only one end. In the illustratedembodiment, a projection 552 with a spherical head 551 extends from theVBR graft 400 and a projection 554 with a spherical head 553 extendsfrom the posterior rod 402. Each end of the stabilizer 404 ^(v) includesa spherical receiving chamber 557 configured to receive a respectivehead 551, 553. A clamp 558 is provided about each end of the stabilizer404 ^(v) to lock the heads 551, 553 within the respective chambers 557.The stabilizer 404 ^(v) allows one or both ends of the stabilizer 404^(v) to be translated along either the VBR graft 400 or the rod 402 andthus allows the stabilizer to fit between the two as the distancebetween them varies. This design allows for the stabilizer 404 ^(v) topush the VBR graft 400 and rod 402 apart as well as push them together.

Referring to FIG. 69, a stabilizer 404 ^(vi) including a screw jackmechanism will be described. The stabilizer 404 ^(vi) includes a post560 extending from the VBR graft 400. The post 560 defines an internalbore 561 and an external groove 562. A post 564 with external threads565 extends from the posterior rod 402. The post 564 extends into thebore 561. A threaded jack 566 includes a flange 567 which engages theexternal groove 562 to retain the jack 566 on the post 560 such that thejack 560 is rotatable about the post 560 but does not move axiallyrelative thereto. Threads 568 on the jack 566 engage the threads 565 onpost 564 such that rotation of the jack 566 pulls or pushes on the post564 to adjust the position of the rod 402 relative to the VBR graft 400.

In the embodiment of FIG. 70, the stabilizer 404 ^(vii) includes a shaft570 with external threads 572. The threaded shaft 570 passively engagesan extension 574 on the rod 402, i.e. the shaft 570 rotates relativethereto but does not translate axially. The opposite end of the threadedshaft 570 threadably engages an extension 576 on the VBR graft 400. Asthe threaded shaft 570 is rotated, the threaded engagement with theextension 576 causes the VBR graft 400 to move toward or away from theposterior rod 402.

Referring to FIGS. 71-72, the stabilizer 404 viii is manufactured from aflexible material. Use of a flexible material to connect the VBR graft400 to the posterior rod 402 allows for compression, extension or bothbetween the two. This design can be combined with any of the aboveembodiments for a custom fit with the ability to absorb some of themotion between the two components without causing the VBR graft 400 tomove.

Although many of the embodiments are described with references to VBR,it will be appreciated that the embodiments may apply equally to aninterbody fusion implant where the vertebra or vertebrae are notremoved.

These and other advantages of the present invention will be apparent tothose skilled in the art from the foregoing specification. Accordingly,it will be recognized by those skilled in the art that changes ormodifications may be made to the above-described embodiments withoutdeparting from the broad inventive concepts of the invention. It shouldtherefore be understood that this invention is not limited to theparticular embodiments described herein, but is intended to include allchanges and modifications that are within the scope and spirit of theinvention as defined in the claims.

What is claimed is:
 1. A method of inserting a prosthetic implant forengagement between first and second vertebrae comprising: providing aprosthetic implant for engagement between first and second vertebraecomprising: a first plate configured for attachment to the firstvertebrae and defining a first interbody connection member; a secondplate configured for attachment to the second vertebrae and defining asecond interbody connection member; and an interbody component includinga body extending between first and second ends, the first end defining afirst plate connection member configured for connection to the firstinterbody connection member and the second end defining a second plateconnection member configured for connection to the second interbodyconnection member, wherein the interbody component is a monolithicstructure coupled to the first and second plates at the first and secondends, and wherein the interbody component does not include any openingsextending through an outer wall of the interbody component; attachingthe first plate to the first vertebra; attaching the second plate to thesecond vertebra; engaging the first and second plates with animplantation instrument; distracting or compressing the first and secondplates away from or toward one another using the implantationinstrument; and positioning the interbody component between the firstand second plates with the first plate connecting member engaged withthe first interbody connecting member and the second plate connectingmember engaged with the second interbody connecting member.
 2. Themethod according to claim 1 wherein the first and second interbodyconnection members have the same configuration.
 3. The method accordingto claim 1 wherein the first and second interbody connection membershave distinct configurations.
 4. The method according to claim 1 whereineach plate comprises a lateral portion configured to extend along asurface of the respective vertebrae.
 5. The method according to claim 4wherein at least one of the plates includes a vertical portion extendingfrom the lateral portion such that the plate has a generally L-shapedconfiguration.
 6. The method according to claim 1 wherein each of theplates defines an instrument receiving opening.
 7. The method accordingto claim 1 wherein at least one of the plate connection members includesa projection with a dovetail configuration and the correspondinginterbody connection member includes a slot with a complementarydovetail configuration.
 8. The method according to claim 1 wherein atleast one of the plate connection members includes a slot with adovetail configuration and the corresponding interbody connection memberincludes a projection with a complementary dovetail configuration. 9.The method according to claim 1 wherein at least one of the plateconnection members includes a slot with a T-shaped configuration and thecorresponding interbody connection member includes a projection with acomplementary T-shaped configuration.
 10. The method according to claim1 further comprising an extension component configured to be positionedbetween the interbody component and one of the plates, the extensioncomponent having connection members configured to engage the interbodyconnection members of the plate and the plate connection members of theinterbody component.